Attention To Detail, Part One: Diagnosis of ADD

Attention Deficit Disorder, or ADD, is characterized by impulsivity and distractibility. When paired with hyperactivity, it is ADHD. Common diagnostic procedure for these conditions (as set by the DSM – a book governing psychiatric diagnosis) is the use of a checklist. If a child or adult exhibits six of the nine characteristics of ADD/ADHD, it is a positive diagnosis. Estimates cited in the New York Times set the amount of children with diagnosed ADD at 7%. Other studies show 5%.

It’s dinner time in the John Doe household.

Mrs. Doe is taking the chicken out of the oven, and her husband is preparing the vegetable. Teenage Jill is checking her friends’ status updates on her smartphone. Her brother Jack is scouring the blogosphere for something worthwhile on the iPad. Little Jimmy is even plugged in; he’s been playing Super Mario Brothers on his 3DS for the past two hours. The normal American family, right?

These days, we’re always plugged in, and the drought of person-to-person contact paired with the plethora of glass screens has begun to cause shortening attention spans and unfounded diagnoses of Attention Deficit Disorder (ADD). Dr. Ned Hallowell, a nationally known expert on the disorders, says that this is “an epidemic problem.”

“I think there’s a condition I call pseudo-ADD,” he says, which “is really caused by the combination of too much electronic technology coupled with not enough human connection.”

“That combination of [being] overstimulated electronically and under stimulated interpersonally causes the very same symptoms: distractibility, impulsivity, and restlessness, and it’s a syndrome that I call … a severe case of modern life!” And how to treat the side effect of the digital age? It’s certainly not Adderall! (See part two.) “The last thing those people need is a diagnosis of ADD and to be put on medication. They need to unplug their electronics and reconnect, and have some family dinners.”

But experts are unsure whether the increased ability to focus on screens for hours at a time is caused by the ADD itself, or if the increased screentime and decreased facetime is causing the short attention spans. Furthermore, the jury’s still out on whether this “extreme case of the modern life” is actually ADD, or the so-called “pseudo-ADD,” as named by Dr. Hallowell.

All of these points bring forth a startling question. For such a common condition – especially in children – do we actually know how to diagnose ADD? Dr. Hallowell thinks so, but a definitive answer can be hard to come by.

“Where non-A.D.D. leaves off and where A.D.D. begins,” he says, “is hard to define. But there’s a great quote: … ‘Although there be not a clear line that can be drawn between night and day, no one would deny there is a difference.’” But how to separate ADD from common distractibility; in the end, they are children. “It’s the intensity and duration as compared to a cohort of your peers,” says Dr. Hallowell, in the categories of “distractibility, impulsivity, restlessness, and is it getting in your way? Is it causing you to underachieve?”

And that raises another question.

Dr. Hallowell says it’s all relative. “You can underachieve and be a straight-‘A’ student, and that’s what so many people don’t get. You can underachieve and be at the top of the class, or the top of a job.” As ADD can be a kickstarter for entrepreneurialism, it can even help. Dr. Hallowell, who tends to see wealthy clients, has treated many such entrepreneurs with otherwise debilitating ADD.

Yes, concedes Dr. Hallowell. These people can fall through the cracks. But, he says, “the damage that’s done is [to] the kids who are trying hard as they possibly can and who are very bright and they still don’t get good results, and are called stupid and lazy.”

So. The modern world may be causing ADD (if it even is ADD), or ADD may amplify the modern world’s effect with an increased, singular focus on screens. We know that ADD exists, and, for the most part, we know it when we see it. But we don’t really know where it truly begins. We know that those with ADD are usually underachieving, but we can’t exactly gauge what underachieving is, because achievement is a relative and subjective measure.

To the second question, yes – and more on that in a while. To the first question: the jury’s still out. In fact, some believe that the disorder doesn’t even exist. On PBS’s Frontline, child psychologist Peter Breggin says (in a rather inflammatory way, I must add), that parents of children with ADD “have been lied to. They’ve been told that children have a neurobiological disorder. They’ve been told their children have biochemical imbalances and genetic defects.”

“On what basis?” he questions. His answer: “That they fit into a checklist of attention deficit disorder, which is just a list of behaviors that teachers would like to see stopped in a classroom?”

Interestingly, and to answer my second question from earlier, the use of hard-evidence brain scans is becoming more common, according to an article from earlier this month by Sabrina Tavernise in the New York Times. “The test,” she writes, “uses an electroencephalogram, or EEG, with sensors attached to a child’s head and hooked by wires to a computer to measure brain waves.” According to the article, “certain combinations of those waves tend to be more prevalent in children with A.D.H.D.” Mr. Breggin, and the many anti-ADD-diagnosis advocates like him, aren’t completely unfounded in their claims; this is the very first FDA-approved brain scan for the disorder, and is still combined with the usual “list of behaviors that teachers would like to see stopped.” It should be noted, however, that Mr. Breggin’s views are certainly in the minority.

Dr. Hallowell provides another medical argument. “The science is right there. The genetic studies are rock-solid. This is one of the most heritable of all traits in all of the behavioral sciences.” Remember, children don’t inherit ADD itself; they may inherit a predisposition for the disorder. Beyond that, “On M.R.I.s,” he says, “the brains are ever so relatively smaller in the corpus callosum [the part of the brain connecting the two hemispheres], the prefrontal cortex, [and] the vermis of the cerebellum” – a part of the brain associated with locomotion.

So. Back to the first question. Why do we – despite the difficulties – even try to diagnose ADD? Because except to the detractors, this condition exists; even if we aren’t perfect, we ought to try our best to diagnose it and make it better.

So maybe teenage Jill, her brother Jack, and little Jimmy have ADD, and maybe they don’t. Maybe they need a family dinner and a good-old-fashioned book, and maybe they need a prescription for Adderall – but that’s an issue for part two!